The LWIC Palliative and End of Life Care work stream supports Health and Social Care Partnerships to test new approaches to identify people who would benefit from palliative and end of life care. It includes new approaches to co-ordinate care that enable people to spend more time living well in the community in the last six months of life that would otherwise be spent in hospital.
Most people say that they would like to be cared for at home when they reach the end of their life, yet only 21% actually die at home.
Investment in community-based palliative care services reduces time spent in hospital at the end of life and is likely to be cost effective. Supporting patients to live well during their final months has the potential to release resources that can be reinvested elsewhere. £104 million could be released for investment elsewhere if emergency admissions were reduced by 10% and the average length of stay following admission was reduced by three days.
In December 2015 the Scottish Government published The Strategic Framework for Action on Palliative and End of Life Care 2016 – 2021. Within the Strategic Framework for Action, the Scottish Government has made ten commitments, Healthcare Improvement Scotland’s ihub has been asked to deliver commitment 1:
“Support Healthcare Improvement Scotland in providing Health and Social Care Partnerships with expertise on testing and implementing improvements in the identification and care co-ordination of those who can benefit from palliative and end of life care.”
About 1% of general practice patients will die each year. It is important to find ways of identifying these patients so that their needs and preferences can be assessed in order to plan for them and to provide the right services at the appropriate time. About one-quarter will die from cancer; these are the patients that have generally been thought of when initially discussing palliative care. In addition about one-third will die from organ failure, e.g. heart failure and COPD, and about one-third will die from multiple organ failure, frailty or dementia.
There are variations in access to palliative care by condition (particularly cancer vs. non-cancer), age, location, ethnicity and the identification challenges posed by multiple medical conditions. Longer periods spent living with life-limiting illness can make it difficult to know when the time is right for professionals to introduce a palliative care approach.
LWIC Palliative and end of life care work stream development
Health and Social Care Partnerships have identified opportunities to test and implement improvements in the identification and care co-ordination of those who can benefit from palliative and end of life care.
Each site has a different context, and by applying improvement methodology, they are finding out what factors and approach lead to proactive identification and better care coordination. This is done by involving people in the conversation to ensure that they get the right care, in the right place at the right time. Initiatives and interventions include:
- East Ayrshire – Provision of a new care home palliative bed, an improved community model for COPD, implementing anticipatory care planning in the community, testing the SPICT/SPICT4ALL and ECOG identification tools
- Fife – Developing a multidisciplinary team approach to co-ordinate palliative care, testing SPICT or Anticipal to support primary care-led identification
- Glasgow – Improving access to palliative care for residents of local authority care homes, testing the SPAR and PPS identification tools
- Dundee – Testing the Advanced Dementia Practice Model in a care home setting, exploring how the FAST and PPP tools support timely identification of those with advanced dementia and palliative care needs
- Perth and Kinross – adapting a local community-based model (Enhanced Community Support to prevent crisis and support early intervention) to detect palliative care needs and supportive approach.
LWIC Palliative and end of life care case study
Testing out a palliative care bed in a care home in East Ayrshire
East Ayrshire Health and Social Care Partnership tested a new initiative to provide a palliative care bed in a local community setting. This short video below explains the improvement journey experienced by residents family and friends, care home staff and improvement advisors in Glebe House care home